Director of Managed Care Contracting - Outpatient Division

ID128651
Full Time Regular
680 American Ave
King Of Prussia, PA 19406
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Job Description

The  Director is responsible for planning, analysis, negotiation, and implementation of new and renegotiated contracts for assigned clinics and markets and will serve as key corporate liaison for Operations and Finance leaders as well as corporate functional support areas.   The focus is on increasing net revenue through favorable contracts that exceed our costs to provide care as well as on capturing maximum referral volume from each executed contract and increasing out of network volume wherever feasible.  

Responsibilities

  • Analyze, negotiate, and implement new and renegotiated contracts for assigned clinic portfolio.  Develop payor strategies to ensure optimal contracting and operational performance for assigned markets. Manage implementation of new contracts and renegotiations and be responsible for rates, payment methodologies, contract language, following all internal controls for contract review, approval, and signature.
  • Corporate Liaison for Operations and key support functions: Implement new contract rollouts and post rollout analysis, work closely with designated Director(s) of Finance regarding changes (positive and negative) impacting reimbursement, discuss strategies to enhance NRPV and contract performance, partner with Legal, Regulatory, and Clinical Services on an as needed basis for contract related questions or issues, and assist Revenue Cycle Managers and CBO with contract related questions or issues.
  • Clinic and Payor Relations: Promote use of Contract Information Systems and other tools, develop and maintain positive payor relations, identify and address issues and respond to inquiries/issues for new and renegotiated contracts.
  • Ensure Clinics maximize utilization of contracts: Participate in new employee orientation of clinical leaders/support staff, obtain payor contacts for new contracts to establish initial and ongoing meetings, and chair quarterly trend report calls and disseminate market trend findings/opportunity and track post meeting action items and status.
  • Business Development and Integration: Oversee contract implementation for new clinic openings/mergers, JV’s, and Acquisitions and work closely with Credentialing department to assure payor credentialing requirements have been met.

Qualifications

  • Bachelor’s degree or higher preferred or equivalent work experience.
  • 3-5 years demonstrated experience in a managed care setting, Outpatient Services setting, preferably working in contracting or provider relations areas.

Select Medical is an EOE.

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